Christopher Hemond
Palo Alto, California, United States

 

MRI of the visual cortex area responsible for facial recognition

The comedian Groucho Marx once said, “I never forget a face, but for you I’ll make an exception.” Inside his humor appears an extraordinary truth—the human ability to effortlessly perceive a face and catalogue it in a mental library many thousands of volumes thick. While Mr. Marx’s derision of his faceless foe remains a matter of comedy for most, to my research subject, Donna, the wisecrack would taste of elemental tragedy: from a very early age she has forgotten most of the faces she has ever seen.

“Was this one?” she asks, her brow furrowed as she stares at a man’s face on the computer screen. I look and recognize that it is one of the faces she has seen just minutes before, as part of a series. The question hangs rhetorical, in silence. Then she looks up from the computer and gives me a warm smile, the corners of her bright eyes revealing the approach of middle age. Returning the smile, I am struck by her remarkable conviviality, given the social burden of her lifelong difficulty with faces.

“So when did you first start noticing it?” I later ask her.

“It was a really gradual thing,” she responds, turning her blue eyes upward. “Probably not until I was 30 did I start thinking, oh, that’s annoying. I just used to think I was bad at recognizing faces.” Perhaps the best way to describe it, she explains, is to imagine finishing a five- or ten-minute conversation with a new acquaintance, only to find that the mental picture of his or her face has vanished, ephemeral. “I wouldn’t have a clue of what they looked like,” she muses.

A neurologic deficit, perhaps, this rare condition has recently been deemed prosopamnesia, the name a chimera of the Greek “prosopon” (meaning face) and the medicalese “amnesia” (a loss of memory). But prominent neurologists may never have heard of it. And although it is possible that Donna’s condition could perhaps be explained by focal damage to certain areas of the brain, it would be a remarkable occurrence. Odds are that her brain would appear normal though—as would the brains of hundreds of other self-identified prosopamnesics who, having heard of it through media channels, are now coming out of the woodwork.

Recent research describes two interesting aspects of this deficit. First, one’s ability to memorize and subsequently recognize faces may be highly determined by one’s genes. ¹ One report estimates that up to a stunning two percent of the population may be terrible at recognizing faces. Interestingly, Donna’s teenage son notices that his ability to remember people seems to be far below that of his peers. A second observation is one’s prowess with faces seems to lie on a spectrum, and not everyone is made equal. Most people are decidedly average, situated near the belly of the bell, but a few are at the fringe. And while Donna’s abilities are unimpressive, there are now published reports of the exact opposite. “Super-recognizers” they are called—individuals who can recognize their childhood lifeguard 20 years later or the plumber who came to pump the flooded basement a decade ago.²

For the prosopamnesics, at the other end of the spectrum, their disability is too subtle, too incomplete, too far woven into the fabric of societal normalcy to attract clinical attention. Moreover, Donna has been able to unconsciously manage her lifelong face troubles through brute attrition: she reports that with enough exposure, she is able to remember—and subsequently recognize—people like close friends, family, and even some celebrities “just fine.” But the mail carrier or the store clerk? Forget about it.

Her coping ability has kept her from ever seeking help. But should she? Could anything be done for it? Is face-forgetting even a disability? Consider for a moment the consequences of constantly forgetting a new face. Groucho Marx’s joke again lends insight into the social nature of humans—what an insult to not be remembered! As Donna vehemently attests, people have often misjudged her as arrogant or ego-centric. Occasionally confronted by her disbelieving acquaintances or professional contacts who are aghast at her poor memory, for Donna, the phrase “You don’t remember me?” frequently signals lost friendship and embarrassment.

Formal neuropsychological testing reveals no problems in her cognition or general memory. She learns motor tasks well and enjoys lucid recall for facts, languages, places, and objects. From her career in journalism, she notes, “I’ve got a really clear memory of what people say, and scripts—I memorize scripts for TV easily, better than most people.” She can also perceive and discriminate between different faces without a problem—an ability that distinguishes prosopamnesia from the closely-related prosopagnosia, a better-known deficit first made famous by Oliver Sack’s classic, The Man Who Mistook His Wife for a Hat. Many prosopagnosics are actually prosopamnesics, although arguing the finer points of face perception are generally left to researchers.

What is so intellectually tantalizing about Donna’s deficit is the extraordinary specificity of her trouble, present from birth; nothing else appears to be wrong with her cognitive faculties. It may also be argued that faces are quite special to the human perceptual systems. Recent brain-scanning techniques have yielded enormous insight into how the human mind perceives and analyzes face information, such as the 1997 discovery of a specific face-processing area of the cortex (the “fusiform face area”) or the neurologic interpretation of autism as a maldevelopment in the brain hardware that naturally attracts one’s attention to a face. And as referenced earlier, the existence of “super-recognizers” implies that the ability to remember a face may be more of a spectrum, ranging from the elite to the unable.

For the moment, however, we must accept prosopamnesia as another neuroscientific curiosity in this world. And Donna has found solace in simply being able to name her diagnosis, an empowerment that allows prosopamnesics their own self-deprecatory perspective on Groucho’s joke: you can pretend to forget me, but I really won’t remember you!

 

References

1. Wilmer JB, Germine L, Chabris CF, et al. Human face recognition ability is specific and highly heritable. Proceedings of the National Academy of Science USA. 2010;107(11):5238-41
2. Russell B, Duchaine B, Nakayama K. Super-recognizers: People with extraordinary face recognition ability. Psychonomic Bulletin & Review. 2009;16(2):252-257

 

---

 

CHRISTOPHER C. HEMOND is finishing his fifth year of medical school at Stanford and currently applying to neurological residency programs across the US. While attending medical school, he has done research in different areas in neurology and psychology, including face perception, the genetics of Alzheimer’s, and electroencephalography/magnetoencephalography techniques. He is an active contributor in Stanford’s Biomedical Ethics and Medical Humanities Program, which affords multiple opportunities to interact with physician writers, ethicists, and humanitarians and to reflect on medicine and the human condition through various artistic mediums.

 

Highlighted in Frontispiece Winter 2012 – Volume 4, Issue 1, and Summer 2017 – Volume 9, Issue 3
Winter 2012  |  Sections  |  Neurology